Diffuse Papular Eruption

An elderly woman of Bahamian heritage with Fitzpatrick VI skin type presented with a 1-week history of indolent papules all over her body. She was otherwise asymptomatic. Findings from physical examination were notable for discrete skin-colored to pink papules coalescing into plaques on her face, trunk (Figure, A and B), and all 4 extremities. There was no scale or other epidermal change. A punch biopsy for hematoxylin-eosin staining was performed (Figure, C). The patient returned 1 week later with worsening cutaneous eruptions and new complaints of fever, weakness, and malaise. Repeat physical examination revealed splenomegaly and axillary lymphadenopathy. A peripheral blood smear (Figure, D) and other diagnostic tests were performed. A B